What is the treatment for a patient diagnosed with mononucleosis (mono) infection?

Treatment of Mononucleosis (Mono) Infection

The treatment for mononucleosis is primarily supportive care, including adequate hydration, analgesics, antipyretics, and appropriate rest, as there is no specific antiviral therapy routinely recommended for this self-limited condition.

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis with:

• Complete blood count (CBC) with differential
  • Look for lymphocytosis (≥50% lymphocytes)
  • Presence of atypical lymphocytes (≥10%)
• Heterophile antibody test (Monospot)
  • Note: May be falsely negative early in infection (first week) or in children under 5 years

If Monospot is negative but clinical suspicion remains high:

• Consider EBV-specific serologic testing (VCA IgM, VCA IgG, EBNA)
• Check liver enzymes (often elevated in mono)
• Consider other causes of mononucleosis-like syndrome (CMV, toxoplasmosis, HIV)

Supportive Treatment Protocol

1. Pain and Fever Management

   • Acetaminophen or NSAIDs for pain and fever
   • Warm salt water gargles for sore throat
   • Adequate hydration

2. Activity Guidelines

   • Rest as needed based on energy levels
   • Avoid contact or collision sports for at least 3-4 weeks from symptom onset 1, 2
   • Return to normal activities gradually as symptoms improve
   • Continue sports restriction if splenomegaly persists

3. Monitoring for Complications

   • Assess for splenomegaly (occurs in ~50% of cases) 3
   • Monitor for signs of airway obstruction from tonsillar enlargement
   • Watch for rare complications like splenic rupture (0.1-0.5% of cases) 3

Special Considerations

Medications NOT Routinely Recommended

• Corticosteroids: Not recommended for routine treatment 1, 2
  • Exception: May be beneficial for severe pharyngeal edema or respiratory compromise
• Acyclovir: Not recommended for routine treatment 1
• Antihistamines: Not recommended for routine treatment 1

Patient Education

• Inform patients that fatigue may persist for several months 1
• Advise about avoiding alcohol during recovery (particularly with elevated liver enzymes)
• Explain the risk of splenic rupture and importance of avoiding contact sports

High-Risk Populations

• Immunocompromised patients require closer monitoring due to risk of severe disease 2
• Consider more aggressive supportive care in patients with significant comorbidities

Return to Activities

1. General Activities

   • Resume as tolerated based on energy levels
   • Gradual return to school/work as symptoms improve

2. Sports Participation

   • Avoid contact sports for minimum of 3-4 weeks from symptom onset
   • Consider ultrasound to confirm resolution of splenomegaly before returning to contact sports
   • Elite athletes may take 3-6 months to regain top form 4

The prognosis for most patients with infectious mononucleosis is excellent, with complete recovery expected, though fatigue may persist for several months in some cases.